Novel TNF antagonists for the treatment of rheumatoid arthritis.

IMPORTANCE OF THE FIELD: TNF antagonists have become an integral part of the standard of care for patients with rheumatoid arthritis (RA). Two additional TNF antagonists have recently been approved in the US for this indication, and clinicians will need to understand the data on the efficacy and safety of these agents in order to properly place them into the clinical treatment algorithm. AREAS COVERED IN THIS REVIEW: This review covers the published clinical trial data on the use of certolizumab and golimumab for RA. The literature search included manuscripts published through September 2009 and abstracts from major meetings (ACR and EULAR) in 2007 - 2009. WHAT THE READER WILL GAIN: This paper will review the efficacy and safety of golimumab and certolizumab in the treatment of RA at various stages of disease. Use of these agents will be described in the context of other available alternatives, including other TNF antagonists and other biologic therapies. TAKE HOME MESSAGE: Certolizumab and golimumab have comparable efficacy and safety profiles compared with previously approved TNF antagonists. These two agents have several unique theoretical benefits when compared to existing agents, but the available published data do not suggest a clear clinical advantage at this time.